Aprotinin in pediatric neuromuscular scoliosis surgery

Abstract

Reduction of blood transfusions in patients with neuromuscular scoliosis can decrease potential complications such as immune suppression, infection, hemolytic reaction and viral transmission. Aprotinin (Trasylol Ò , Bayer), an antifibrinolytic, has proven to be effective in reducing blood loss in cardiac and liver surgery, but little data exists in patients undergoing spinal fusion for neuromuscular scoliosis. The purpose of this study was to evaluate the safety and efficacy of aprotinin in pediatric neuromuscular scoliosis patients undergoing spinal fusion. The medical records of all patients undergoing initial spinal fusions for neuromuscular scoliosis between January 1999 and March 2003 were reviewed to determine demographic data, perioperative data, wound drainage and number of transfusion required. Cases were compared to a matched group of historical controls. We had 14 patients in the aprotinin group and 17 in the control group. Total blood loss in the aprotinin group was significantly lower compared to the control group (715 vs. 2,110 ml; P = 0.007). Significantly less blood loss occurred in the aprotinin group when blood loss per kilogram was evaluated as well (23 vs. 60 ml/kg, respectively; P = 0.002). Intra-operative packed red blood cell (PRBC) transfusions were also significantly lower in the aprotinin group (1.25 vs. 3.16 units; P = 0.001). No clinical evidence of anaphylaxis, deep vein thrombosis (DVT) or renal failure was observed in the aprotinin group. After considering the price of drug therapy, operating room time, and the cost of blood products, the use of aprotinin saved an average of $8,577 per patient. In our series, the use of aprotinin resulted in decreased blood loss and a decreased rate of transfusions in children with neuromuscular scoliosis undergoing extensive spinal fusion. At out institution, the use of aprotinin is safe and cost effective for patients with neuromuscular scoliosis.

Are Antifibrinolytics Helpful in Decreasing Blood Loss and Transfusions During Spinal Fusion Surgery in Children With Cerebral Palsy Scoliosis?

“…4 , 7 Thompson et al 11 studied the role of EACA in neuromuscular scoliosis and found that it reduced blood loss and transfusion requirements. Kasimian et al 12 reported similar results with the use of aprotinin in 14 patients. Shapiro et al 13 showed the effi cacy of TXA in reducing intraoperative blood loss and transfusions in patients with DMD scoliosis.…”

Surgical treatment of neurological scoliosis using hybrid construct (lumbar transpedicular screws plus thoracic sublaminar acrylic loops)

“…Kasimian et al [16] have shown that the use of an antifibrinolytic (Aprotinin) resulted in decreased blood loss and decreased rate of transfusions in children with neuromuscular scoliosis undergoing extensive spinal fusion. In the experience it was intraoperatively used Caprolisin Ò (aminocaproic acid) with mean blood loss of 1200 ± 400 ml.…”

Quality assessment of economic evaluation studies in pediatric surgery: A systematic review

“…The use of aprotinin reduced perioperative blood loss and need for transfusion in neuromuscular scoliosis patients undergoing extensive spinal surgery and saved an average of $8,577 per patient [48].…”